Provider Demographics
NPI:1396888145
Name:DEXTER CHIROPRACTIC
Entity type:Organization
Organization Name:DEXTER CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:DEXTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:740-376-9944
Mailing Address - Street 1:325 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-2002
Mailing Address - Country:US
Mailing Address - Phone:740-376-9944
Mailing Address - Fax:740-376-0094
Practice Address - Street 1:325 4TH ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-2002
Practice Address - Country:US
Practice Address - Phone:740-376-9944
Practice Address - Fax:740-376-0094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1730111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0855614Medicaid
OH0855614Medicaid
OHU28145Medicare ID - Type Unspecified